what to do with medicare wheelchair

1. Get on Medicare. If you are over the age of 65, a US citizen, and having paid into Social Security through your job for at least 10 years, you ...
2. Schedule a doctor's appointment. Medicare will require a signed Certificate of Necessity from a doctor for your wheelchair.
3. Explain to your doctor why you need a wheelchair. Explain the specific issues you are having or tasks you cannot perform as a result of your condition.
4. Make sure you will be able to operate the wheelchair safely. A wheelchair is a substantial piece of equipment, and one that will take some time to use properly.
Decide on the wheelchair that is best for you. The Certificate of Necessity will have to note the type of wheelchair you need.
Get the signed Certificate of Necessity. Once you have demonstrated need to your doctor, and decided upon the proper wheelchair for you, he or she can sign the necessary ...

Full Answer

Are wheelchairs covered under Medicare?

Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home. You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair.

How to get a motorized wheelchair through Medicare?

Sep 12, 2018 · Is there Medicare coverage for a power wheelchair? In some cases, Medicare coverage is available for a power wheelchair. You must have a face-to-face exam with the doctor who is recommending the power wheelchair and he or she will have to write an order for it, explaining to Medicare why you need a power wheelchair and certifying that you are physically …

Is a wheelchair covered by Medicare?

Medicare’s Wheelchair & Scooter Benefit Revised October 2019 Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters), walkers, and wheelchairs as durable medical equipment (DME). Medicare helps cover DME if: • The doctor treating your condition submits a written order stating that you

What are the Medicare requirements for a wheelchair?

Medicare covers durable medical equipment if it is reusable – such as wheelchairs and walkers – and if your doctor prescribes it as medically necessary for use in your home. In order for Medicare to pay for your wheelchair or walker, it must meet the following requirements: Only manual wheelchairs qualify as durable medical equipment. Power wheelchairs are only covered by …

How often does Medicare pay for a wheelchair?

Are wheelchairs covered under Medicare?

What kind of wheelchairs Does Medicare pay for?

Does Medicare cover mobility help at home?

Will Medicare pay for a transport chair?

How much does the wheelchair cost?

What qualifies for a wheelchair diagnosis?

Does Medicare pay for canes and walkers?

Does Medicare cover a rollator walker?

Will Medicare pay for a handicap shower?

Does Medicare cover bathroom equipment?

Why do doctors not like Medicare Advantage plans?

Why do we need a wheelchair?

You need a wheelchair to help you with daily activities of living such as going to the bathroom, bathing, dressing, getting in and out of bed. You are physically able to safely operate a wheelchair or you have someone in the home that is always available to help you use it safely.

What is Medicare Advantage Plan?

Medicare Advantage plans are offered by private insurance companies approved by Medicare and are able to offer additional benefits not available under Original Medicare (Part A and Part B ).

Does Medicare Advantage cover dental?

Although they must include all the coverage under Original Medicare (except for hospice care, which is still covered under Part A), most Medicare Advantage plans include Part D coverage for prescription drugs as well as coverage for routine vision, dental, and even hearing care.

Does Medicare Part B cover wheelchairs?

If you have mobility problems and your doctor recommends a wheelchair or other device to help you get around, Medicare Part B may cover 80% of the allowable charges after you’ve met your deductible as long as you meet certain eligibility requirements.

What is the Medicare deductible for a wheelchair?

You must meet your Part B deductible before Medicare will pay for your wheelchair or walker. In 2019, the annual Part B deductible is $185.

What medical equipment is covered by Medicare?

Wheelchairs and walkers are not the only items designed to help with mobility that are covered by Medicare. Similar items that may qualify as durable medical equipment and can be covered by Medicare include: 1 Rollators 2 Power scooters 3 Crutches 4 Canes 5 Patient lifts 6 Therapeutic shoes or inserts for people with severe diabetic foot disease 7 Prosthetic legs 8 Leg braces

What is Medicare approved amount?

The Medicare-approved amount is the amount that Medicare has declared it will pay the supplier in exchange for the item. The 20 percent share that you are responsible for is your Medicare Part B coinsurance. Each supplier of durable medical equipment falls into one of three categories:

What are the aging in place items covered by Medicare?

Starting in 2019, a set of additional benefits approved for coverage by Medicare Advantage plans may include a number of “aging in place” items, such as home wheelchair ramps and bathroom grab bars. Check plan benefits to see if these services or items may be covered.

How long does a wheelchair last?

The wheelchair or walker must be considered “durable,” or able to withstand repeated use and likely to last for three years or more. The item must serve a medical purpose. Durable medical equipment is covered under Medicare Part B medical insurance.

How much is Medicare Part B?

Medicare Part B also requires a monthly premium of $135.50 in 2019 (although higher-income earners may have to pay more ). The Part B deductible, coinsurance and excess charges may be covered by certain Medicare Supplement Insurance plans.

Is a manual wheelchair considered durable medical equipment?

Only manual wheelchairs qualify as durable medical equipment. Power wheelchairs are only covered by Medicare when determined to be medically necessary (such as when the beneficiary is unable to operate a manual wheelchair).

How to purchase a wheelchair from Medicare?

Find a supplier approved by Medicare. Medicare will only pay for costs that they approve, so purchase your wheelchair at a medical supply store that is approved by Medicare. You can find those stores either by calling Medicare directly at 1-800-MEDICARE (1-800-633-4227) or searching through their online directory at https://www.medicare.gov/SupplierDirectory/. You are looking for a supplier that sells Durable Medical Equipment (DME).

How long does Medicare cover wheelchair rental?

If you rent, Medicare will cover rental costs for up to 13 months. After 13 months, you will own the equipment.

What percentage of Medicare Part B is wheelchair?

Assuming you meet the deductible, Medicare Part B will cover 80 percent of the wheelchair cost, meaning you will pay 20 percent. If you are unable to pay that 20 percent, you may be able to get additional assistance through the Medicare Savings Program.

What type of wheelchair do you need for a certificate of necessity?

In general, there are three different types of wheelchairs: a manual wheelchair, power-operated vehicle, or power wheelchair. A manual wheelchair is powered by you or someone else pushing it.

What is Medicare Part A?

Once you apply for Social Security benefits, you will be automatically enrolled in Medicare Part A, which covers hospital care, and Part B, which covers medical services and supplies. These two parts together are sometimes called "Original Medicare."

How to explain wheelchair to doctor?

Explain to your doctor why you need a wheelchair. Explain the specific issues you are having or tasks you cannot perform as a result of your condition. Provide your doctor with as much detail as possible in your answers. You will also want to be sure that a wheelchair will solve your issues, and not some other piece of equipment, like a cane, crutches, or a walker.

What is a manual wheelchair?

A manual wheelchair is powered by you or someone else pushing it. If you have enough upper body strength to maneuver the chair, or you have someone able to push you around, you can qualify for a manual wheelchair.

Why do you need a manual wheelchair?

Some physicians might recommend a manual wheelchair if you have upper body strength and a person to assist at home with mobility issues.

How long can a wheelchair be used?

A wheelchair is eligible for replacement or refund if it is lost, stolen, damaged, or used for more than 5 years. For rentals, Medicare pays each month for equipment.

What to check before receiving DME?

Before you receive DME, it is crucial to check with your medical equipment supplier to see if they are enrolled in Medicare. Assignment means the medical supplier can cost you only coinsurance and Part B deductible health plans.

Is a wheelchair a medical necessity?

Because DME is essentially a prescription, wheelchairs and other durable medical equipment (DME) are technically a medical necessity.

Can you get wheelchair coverage while away from home?

In order to qualify for wheelchair coverage, you must not have mobility issues that negatively impact your daily activities when you are away from home.

Do wheelchairs get financial aid?

Yes! A lot of wheelchair grants are accessible to people in need of financial aid. All types of non-profit organizations and community groups offer grants.

Can Medicare refuse to pay claims?

They can refuse to pay claims if one or both individuals are not enrolled in Medicare.

How much does Medicare pay for a wheelchair?

If you have Original Medicare, you will likely pay 20% of the Medicare-approved amount of the wheelchair after you have paid your Part B deductible. Medicare Advantage plans are required to provide at least the same benefits as Part A and Part B, but many offer additional coverage.

What does it mean to be in a wheelchair?

If an illness has limited your mobility, a wheelchair can mean the difference between independence and assisted living, especially if you need help performing activities of daily living, such as bathing and dressing. If you are eligible for Medicare because you are 65 years of age or older, or have a disability and receive Social Security benefits ...

Does Medicare require prior authorization for wheelchairs?

If your physician prescribes one of these wheelchairs, your DME supplier will usually submit a prior authorization request and all documentation to Medicare on your behalf. Medicare will review the information to make sure that you’re eligible and meet all requirements for the power wheelchair.

Can you get a power wheelchair covered by Medicare?

A power wheelchair may be available and covered by Medicare if you have a face-to-face visit with a physician who writes a prescription for the equipment.

Do you have to get prior authorization for a wheelchair?

Starting on September 1, 2018, you may have to get prior approval ( known as “prior authorization”) for certain types of power wheelchairs. Under this program, 33 types of power wheelchairs require “prior authorization” before Medicare will pay for them. If your physician prescribes one of these wheelchairs, your DME supplier will usually submit ...

Can you get a manual wheelchair with Medicare?

If you can’t operate a manual wheelchair , you may qualify for a power-operated vehicle. You must be able to get in and out of the scooter by yourself, and safely manage the controls. A power wheelchair may be available and covered by Medicare if you have a face-to-face visit with a physician who writes a prescription for the equipment.

How to get a wheelchair?

1. What you need from your doctor: 1 You must see your doctor and the doctor must prescribe a wheelchair for you. 2 The doctor must explain in writing that you need the wheelchair to get around in your home, that a walker or cane will not give you the mobility you need. 3 If the doctor is prescribing a power wheelchair or scooter, you must not be able to use a manual wheelchair. 4 Whether a manual or a power wheelchair, the doctor must describe the reason you need the wheelchair—for example, you have difficulty getting out of bed, getting dressed, going to the bathroom and performing other activities of daily living. The doctor also must state that you are able to use the wheelchair on your own or with assistance from someone who will be with you in your home.

How much does a wheelchair cost?

Wheelchairs can cost a crazy amount of money, anywhere from $500 to $6000. Fortunately, Medicare will pay for a manual or motorized wheelchair if you meet the coverage conditions, and a doctor prescribes one.

What do you need from your doctor?

1. What you need from your doctor: You must see your doctor and the doctor must prescribe a wheelchair for you. The doctor must explain in writing that you need the wheelchair to get around in your home, that a walker or cane will not give you the mobility you need. If the doctor is prescribing a power wheelchair or scooter, ...

Does Medicare cover wheelchairs?

Keep in mind that Medicare will not cover a wheelchair if you do not need it for use in your home, even if you need it to get around outside. However, if you need it for use in your home, you are free to use it outside your home as well. Here’s more from Just Care:

Can you use a wheelchair on your own?

The doctor also must state that you are able to use the wheelchair on your own or with assistance from someone who will be with you in your home. 2. Where to get your wheelchair. If you have traditional Medicare, you must get the wheelchair from a Medicare contract supplier.

Can you use a manual wheelchair with a power wheelchair?

If the doctor is prescribing a power wheelchair or scooter, you must not be able to use a manual wheelchair. Whether a manual or a power wheelchair, the doctor must describe the reason you need the wheelchair—for example, you have difficulty getting out of bed, getting dressed, going to the bathroom and performing other activities of daily living.

Getting Wheelchairs Covered by Medicare

Caitlin McCormack Wrights has over a decade of experience writing hundreds of articles on all things finance. She specializes in insurance, mortgages, and investing and relishes making dull subject matter gripping and everyday topics amazing. Caitlin has a bachelor's from Duke and a master's from Princeton.

Does Medicare Pay for Wheelchairs?

Medicare Part B pays for wheelchairs when your doctor or other health care provider deems it a necessity for treating your medical condition at home. In this case, a nursing home or hospital providing Medicare-covered care won’t qualify as your home, but a long-term care facility would.

Renting vs. Buying

If your DME supplier is enrolled in Medicare, they’ll know outright if Medicare lets you buy or pays for you to rent a specific DME. Medicare typically pays for most durable medical equipment on a rental basis, and only buys inexpensive or routinely bought equipment such as walkers, blood sugar monitors, or complex rehabilitative power wheelchairs.

How To Get Medicare To Pay for Your Wheelchair

Medicare Part B pays for your wheelchair if a qualified practitioner prescribes it for use in your home and documents the medical necessity as per the coverage requirements. Here’s how the process works.

How To Appeal a Denial of Coverage

Medicare Advantage Plans must pay for the same medically necessary equipment and services as Medicare Part A and B. If your Medicare plan won’t pay for a wheelchair you believe you need, you may appeal the denial of coverage and get an independent review of your request.

What Costs You Need To Cover

If Medicare approves coverage of your wheelchair, you still have a financial obligation to meet. Customary with any health insurance, you must meet your Part B deductible for that year, then cover 20% of the Medicare-approved amount. Usually, this approved amount won’t exceed the actual charge or fee Medicare sets for the item. 5

The Bottom Line

Wheelchairs and related DME supplies are important services covered by Medicare that enable individuals to complete activities of daily living and facilitate their recovery after a hospital stay.

How much does Medicare pay for a wheelchair?

Medicare Part B pays 80 percent of the cost of a wheelchair after you have met your annual deductible. You will pay 20 percent of the cost in addition to your annual Medicare premiums. You may also have copay costs associated with any doctor visits necessary to get your wheelchair.

Why do people need a wheelchair?

If a medical condition is keeping you from moving freely around your house and a cane or walker just isn’t enough, a wheelchair might be the answer to your mobility issues.

What to do if your Medicare request is denied?

If your request is denied, work with your doctor and DME supplier to provide the additional information Medicare needs.

What is a DME wheelchair?

Wheelchairs are considered durable medical equipment (DME). There are three basic types of wheelchairs: manual wheelchairs, power scooters, and power wheelchairs. Which type of wheelchair Medicare will cover depends on your physical condition and your doctor’s recommendations.

What happens if Medicare doesn't approve my purchase?

If Medicare doesn’t approve your purchase, you have the right to appeal that decision. You or your medical equipment provider can explain in more detail why you need the device to function in your home. To see the 33 types of power scooters and power wheelchairs that need prior authorization, check the current list here.

How much does Medicare Part B cover?

If you have a health condition that limits your mobility in your home and keeps you from being able to take care of your daily needs, Medicare Part B will cover 80 percent of the cost. You will be responsible for paying for the remaining 20 percent of the cost, along with your deductible, premium payments, and any related copayments.

What percentage of Medicare Part B is wheelchair?

If your doctor believes you will need a lift to help you get from a bed into your wheelchair, Medicare Part B will cover 80 percent of that expense. You will be responsible for the remaining 20 percent of the cost.